Nursing Mistakes Kill, Injure Thousands

Cost-cutting Exacts Toll On Patients, Hospital Staffs

Overwhelmed and inadequately trained nurses kill and injure thousands of patients every year as hospitals sacrifice safety for an improved bottom line, a Tribune investigation has found.

Since 1995, at least 1,720 hospital patients have been accidentally killed and 9,584 others injured from the actions or inaction of registered nurses across the country, who have seen their daily routine radically altered by cuts in staff and other belt-tightening in U.S. hospitals.

Registered nurses are the primary sentinels of patient care, providing first warning and rapid intervention for those too sick to help themselves. But the majority of hospitals in Chicago and nationally are quietly eliminating or supplanting the role of their best-trained, highest-paid nurses, creating a harried work environment that often compromises patient welfare.

The Tribune analyzed 3 million state and federal computer records to create a database that, for the first time, quantifies the hidden role registered nurses play in medical errors. Because of incomplete reporting in the medical field, these numbers only hint at the full scope of the problem.

And because of lax disciplinary oversight in most states, including Illinois, nurses who make errors or have problems such as a drug addiction rarely receive severe punishment; sometimes they travel to a new state to practice again.

Lapses in nursing care sometimes have only minor consequences, but many are fatal:

In Chicago, at Rush-Presbyterian-St, Luke's Medical Center, 2-year-old Miguel Fernandez received a deadly overdose of sedatives from a newly graduated nurse who was left alone to perform a delicate medical procedure without training.

In Denver, Mary Heidenreich, 78, was killed early last year when a nurse, who reported being overwhelmed with the care of 15 patients, inadvertently delivered a fatal dose of drugs into an intravenous line.

At a Wichita, Kan., hospital where staff shortages left up to 20 critically ill patients in the hands of one nurse, patient Deedra Tolson, 38, bled to death unnoticed after a hysterectomy and 61-year-old Shirley Keck's pleas for help went unanswered until she suffered permanent brain damage.

State and national disciplinary records indicate, and researchers agree, that registered nurses long have been responsible for more patient deaths and injuries each year than any other health-care professional--largely because they have more contact with patients. But the errors have intensified in recent years as working conditions have put more pressure on nurses.

Although most nurses perform their jobs with distinction, they increasingly find themselves both victims of hospital mismanagement and perpetrators of medical errors, forced to walk a thin line between do no harm and doing the impossible.

"Do you know how afraid I was that I was going to fry somebody?" said Marge Sampson, 55, a registered nurse who worked two decades at the state's largest public hospital, the University of Illinois at Chicago Medical Center, before stress drove her to a medical office job.

"It's so scary to spend eight hours, flying by the seat of your pants and just praying," she said. "In my day, they taught you never to give a drug until you looked it up and verified the proper doses. But you can't do that. There's no time. You're just dumped into this. It's so nightmarish I can't even explain."

In a marked departure from previous assertions, officials with the American Hospital Association, the trade group for 5,000 hospitals, acknowledge that patients are being placed at risk due to inadequate staffing and insufficient training.

The dramatic changes that have rocked nursing in recent years have come as managed care programs grew in dominance and federal Medicaid reimbursements dropped--two trends that are squeezing hospital profit margins as never before, said Rick Wade, senior vice president for communications at the AHA.

But, the Tribune found, nursing services have been deliberately cut even in financially thriving hospitals--the result of staff reductions used to preserve historic profit levels.

AHA President Dick Davidson warned hospital executives nationally in 1996 that the public was beginning to discover the "thinness" of nurse staffing, according to a copy of a confidential 19-page report obtained by the Tribune.

To track nursing errors, the Tribune analyzed computerized records from the U.S. Food and Drug Administration and Health and Human Services Department. Also examined were federal and state files of annual hospital surveys and complaint investigations, court and private health-care files, and nurse disciplinary records from every state.